Innovative reading workflows for enterprise radiology

Innovative reading workflows for enterprise radiology
Merge PACS™ Innovative reading workflows for enterprise radiology IBM Watson Health / © 2019 IBM Corporation / PAX Rev 4.0 IBM Watson Health / © 2019 IBM Corporation

IBM’s statements regarding its plans, directions and intent are subject to change or withdrawal without notice at IBM’s sole discretion Information regarding potential future products is intended to outline our general product direction and it should not be relied on in making a purchasing decision. The information mentioned regarding potential future products is not a commitment, promise, or legal obligation to deliver any material, code or functionality. Information about potential future products may not be incorporated into any contract. The development, release, and timing of any future features or functionality described for our products remains at our sole discretion. IBM Watson Health / © 2019 IBM Corporation / PAX Rev 4.0

800M 94B 30K Exams Images Radiologists
IBM Watson Health / © 2019 IBM Corporation / PAX Rev 4.0

Critical healthcare challenges
Heavy reading workload Fragmented IT infrastructure Impaired collaboration 50% 30% 78% Source: 1 Medscape Lifestyle Report 2016: Bias and Burnout. 2 Size should matter, PWC Strategy&,2016 3 Spok, 2017, The Evolution of Mobile Strategies in Healthcare Survey Results of radiologists have reported symptoms of burnout1 in cost savings remain unrealized due to a lack of system integration2 of surveyed providers had physician-to-physician communication as a key goal3 IBM Watson Health / © 2019 IBM Corporation / PAX Rev 4.0

What is Merge PACS? Merge PACS is an AI-ready workflow platform that simplifies physicians’ reading activities and empowers IT leaders with advanced control of the flow of studies throughout the enterprise. Beyond enabling the consolidation of multiple reading specialty systems, Merge PACS is uniquely designed to handle high- enterprise imaging volumes, perform in diverse reading environments and helps providers to scale their delivery of care. Simplify clinical workflows Orchestrate the flow of studies Streamline critical communications Access advanced analytics and AI-enabled solutions IBM Watson Health / © 2019 IBM Corporation / PAX Rev 4.0 IBM Watson Health / © 2019 IBM Corporation

Simplify workflows for better patient outcomes
Build a comprehensive view of patient cases – Read multiple sub-specialty exams and their related prior studies on one single platform. – Easily access patient information from the EHR or from IBM Watson Imaging Patient Synopsis to get a single- view summary with relevant EHR information…in seconds. Focus on patient studies despite interruptions – Receive real-time case updates* in the worklist. – Automatically start the next case in the worklist upon closing the current interpretation. ⃰ Patented IBM Watson Health technology IBM Watson Health / © 2019 IBM Corporation / PAX Rev 4.0 IBM Watson Health / © 2019 IBM Corporation

IBM Watson Imaging Patient Synopsis is…
Clinically focused Alerts radiologists of patient history that could have an impact on the read but may be difficult to access quickly. Expansively informed Presents radiologists with patient context based on a variety of structured and unstructured data. Carefully connected Provides radiologists with easy and direct access to unstructured source data should they need more details during image interpretations. IBM Watson Health / © 2019 IBM Corporation / PAX Rev 4.0

Simplify workflows for a better reading experience
Enjoy an intuitive reading process – Seamlessly launch secondary viewers and other radiology applications from a single worklist. – Load studies on-the-fly due to the elimination of server pre-fetching. Read studies seamlessly throughout the enterprise – Launch a web-based client* to read studies at any reading location. – Read with the same consistent reading experience due to a powerful back-end that allows seamless remote, distributed and teleradiology activities. ⃰ Merge PACS is not FDA cleared for diagnostic use on mobile devices IBM Watson Health / © 2019 IBM Corporation / PAX Rev 4.0 IBM Watson Health / © 2019 IBM Corporation

Control the flow of studies to scale business activities
Expand business coverage – Serve geographically-dispersed markets and activities across multiple states. – Handle heavy workloads across the enterprise. Hedge against service interruptions – Be protected with a disaster recovery infrastructure based on a completely replicated, active environment. – Automatically re-route studies to the next available physicians throughout the enterprise. IBM Watson Health / © 2019 IBM Corporation / PAX Rev 4.0 IBM Watson Health / © 2019 IBM Corporation

Control the flow of studies to optimize resources
Automate the distribution of studies – Systematically distribute or re-distribute studies to the best reader based on a set of attributes such as specific specialties, reading hours and credentials. – Balance the reading workload on the fly across the enterprise to avoid bottlenecks and reduce turnaround time. Simplify the management of studies – Streamline complex workflows with a highly flexible rule- based engine. – Test drive and audit the engine to build and confirm the desired decision tree. IBM Watson Health / © 2019 IBM Corporation / PAX Rev 4.0 IBM Watson Health / © 2019 IBM Corporation

Streamline critical communications to empower caregivers
Foster collaborations across the enterprise – Facilitate immediate consultations with experts via an embedded instant messaging application. – Easily access and audit critical exchanges among stakeholders using the worklist. Accommodate multiple workflows natively – Automate simultaneous workflows, such as those for ER discrepancy and critical results, with a multi-dimensional worklist. – Follow a smarter configurable composite worklist with sections focused on specific criteria, such as urgency and sub-specialties. IBM Watson Health / © 2019 IBM Corporation / PAX Rev 4.0 IBM Watson Health / © 2019 IBM Corporation

Access advanced analytics to drive awareness and results
Capture all contributions – Allow reading physicians to view real-time progress on their personal reading goals by displaying statistics such as the number of studies and work units completed (RVU). – Empower radiologists to report both reading and non- reading work such as time spent on teaching, conference presentations or tumor boards. Measure reading activities and IT performances – Automate the monitoring of your IT systems and the reception of alert messages. – Understand how your organization performs with enterprise-wide reports on reading activities. IBM Watson Health / © 2019 IBM Corporation / PAX Rev 4.0 IBM Watson Health / © 2019 IBM Corporation

IBM Watson Health: Our imaging AI journey
IBM Watson Imaging Patient Synopsis IBM Watson Imaging Clinical Review* (image and text analytics for UK/Ireland) Watson Imaging Care Advisor offerings** Visionary slide IBM Watson Imaging Clinical Review (text analytics for US) IBM Imaging AI Marketplace IBM Watson Imaging Clinical Review** (image and text analytics for US) *Not for sale in U.S. Not approved or cleared by US FDA. **This technology is in the research and development phase and has not been evaluated by any regulatory agencies (such as USFDA) for safety or efficacy. It is not available for any commercial or non commercial use. Information about R&D stage technology is shared only for purposes of feedback and research recruitment. IBM Watson Health / © 2019 IBM Corporation / PAX Rev 4.0 Group Name / DOC ID / Month XX, 2019 / © 2019 IBM Corporation

Collaboration and Image Sharing
A robust foundation for enterprise imaging with an industry-leading portfolio EHR Integration Watson Health Imaging AI Collaboration and Image Sharing View Orthopedics Image management Capture Cardiovascular Non-DICOM Radiology Mobile AI IBM Watson Health / © 2019 IBM Corporation / PAX Rev 4.0

With Merge PACS 8.1 you can…
Mammo 3D/2D Toggle We have supported 3D Mammo in Merge PACS for some time now. What we are adding in 8.1 is the ability to toggle bidirectionally between the Tomo and 2D images of the same projection in a single click, all while independently maintaining the presentation of each view. Auto registration In 8.0, you can correlate locations between series in the same study with the same frame of reference. In 8.1, you can now correlate locations between series in different studies (different frames of reference) through features such as linked/synchronized scrolling, 3D cursor tool and cross- reference lines. Seamless third-party advanced visualization integration In 8.1, we have added the ability to launch a series into TeraRecon embedded within Merge PACS itself, all without leaving the Merge PACS viewer. Volume PET/CT SUV tool 8.0 supports SUV measuring in our ROI and Probe tools, but now we offer two new tools in 8.1, Region Analysis Area and Region Analysis Volume, which allow SUV to be calculated within a volume and based on original image data, while including all measurements indicated in the QIBA profile. Improved Patient Synopsis integration In 8.1, Patient Synopsis can now be embedded directly in the Merge PACS patient record. This provides an easy way to gain quick access to the valuable information from Patient Synopsis without having to launch or switch to a separate application. IBM Watson Health / © 2019 IBM Corporation / PAX Rev 4.0

Thank you IBM Watson Health linkedin.com/showcase/ibmwatsonhealth
CONTACT US FOLLOW US IBM Watson Health 71 S. Wacker Drive, 20th Floor Chicago, IL phone fax toll-free linkedin.com/showcase/ibmwatsonhealth twitter.com/IBMWatsonHealth

Legal Disclaimer © IBM Corporation 2019. All Rights Reserved.
The information contained in this publication is provided for informational purposes only. While efforts were made to verify the completeness and accuracy of the information contained in this publication, it is provided AS IS without warranty of any kind, express or implied. In addition, this information is based on IBM’s current product plans and strategy, which are subject to change by IBM without notice. IBM shall not be responsible for any damages arising out of the use of, or otherwise related to, this publication or any other materials. Nothing contained in this publication is intended to, nor shall have the effect of, creating any warranties or representations from IBM or its suppliers or licensors, or altering the terms and conditions of the applicable license agreement governing the use of IBM software. References in this presentation to IBM products, programs, or services do not imply that they will be available in all countries in which IBM operates. Product release dates and/or capabilities referenced in this presentation may change at any time at IBM’s sole discretion based on market opportunities or other factors, and are not intended to be a commitment to future product or feature availability in any way. Nothing contained in these materials is intended to, nor shall have the effect of, stating or implying that any activities undertaken by you will result in any specific sales, revenue growth or other results. Performance is based on measurements and projections using standard IBM benchmarks in a controlled environment. The actual throughput or performance that any user will experience will vary depending upon many factors, including considerations such as the amount of multiprogramming in the user's job stream, the I/O configuration, the storage configuration, and the workload processed. Therefore, no assurance can be given that an individual user will achieve results similar to those stated here. All customer examples described are presented as illustrations of how those customers have used IBM products and the results they may have achieved. Actual environmental costs and performance characteristics may vary by customer. IBM, the IBM logo, ibm.com, Watson, and Watson Health are trademarks of International Business Machines Corp., registered in many jurisdictions worldwide. Other product and service names might be trademarks of IBM or other companies. A current list of IBM trademarks is available on the Web at “Copyright and trademark information” at ibm.com/legal/copytrade. IBM Watson Health / © 2019 IBM Corporation | SM-249 Rev 1.0 IBM Watson Health / © 2019 IBM Corporation

Forward Looking Statements
Certain statements contained in this presentation may constitute forward-looking statements within the meaning of the Private Securities Litigation Reform Act of Forward-looking statements are based on the company’s current assumptions regarding future business and financial performance. These statements involve a number of risks, uncertainties and other factors that could cause actual results to differ materially, including the following: a downturn in the economic environment and client spending budgets; the company’s failure to meet growth and productivity objectives; a failure of the company’s innovation initiatives; risks from investing in growth opportunities; failure of the company’s intellectual property portfolio to prevent competitive offerings and the failure of the company to obtain necessary licenses; cybersecurity and data privacy considerations; fluctuations in financial results; impact of local legal, economic, political and health conditions; adverse effects from environmental matters, tax matters and the company’s pension plans; ineffective internal controls; the company’s use of accounting estimates; the company’s ability to attract and retain key personnel and its reliance on critical skills; impacts of relationships with critical suppliers; product quality issues; impacts of business with government clients; currency fluctuations and customer financing risks; impact of changes in market liquidity conditions and customer credit risk on receivables; reliance on third party distribution channels and ecosystems; the company’s ability to successfully manage acquisitions, alliances and dispositions; risks from legal proceedings; risk factors related to IBM securities; and other risks, uncertainties and factors discussed in the company’s Form 10-Qs, Form 10-K and in the company’s other filings with the U.S. Securities and Exchange Commission (SEC) or in materials incorporated therein by reference. The company assumes no obligation to update or revise any forward-looking statements. These charts and the associated remarks and comments are integrally related, and are intended to be presented and understood together. IBM Watson Health / © 2019 IBM Corporation IBM Watson Health / © 2019 IBM Corporation

Appendix

Merge PACS 8.1 Mammo tool – Gives the user the ability to quickly toggle between 2D and tomosynthesis series of the same projection within a study. Volume SUV tool – Following new standards from Quantitative Imaging Biomarkers Alliance to do volumetric standard uptake values. The tool finds the S.U.V values within a spherical volume in multiple planes. IBM Watson Health / © 2019 IBM Corporation / PAX Rev 4.0 IBM Watson Health / © 2019 IBM Corporation

Merge PACS 8.1 Auto Registration
– Anatomical linking across the comparison and up to 3 priors – Links CT, MRI and PET CT – Adjust the registration on the fly – Reference lines on all series – 3D spatial tool to line up on the same location across all planes IBM Watson Health / © 2019 IBM Corporation / PAX Rev 4.0 IBM Watson Health / © 2019 IBM Corporation

More on integral specialized viewing tools
Fast 3D with MIP, MPR, volume rendering – CPU-based rendering Mammography – Mammo-specific tools included – Tomosynthesis viewing with full 3D PT/CT/MR fusion – Comprehensive fusion – Standardized uptake value (SVU) measurements Advanced 3D and SSR viewers – Launch third-party server-side rendering viewers in context IBM Watson Health / © 2019 IBM Corporation / PAX Rev 4.0 IBM Watson Health / © 2019 IBM Corporation

Enterprise imaging integration with direct access to IBM iConnect Access
IBM Watson Health / © 2019 IBM Corporation / PAX Rev 4.0 IBM Watson Health / © 2019 IBM Corporation

More on hanging protocol (HP)
Challenges Rules engine to the rescue Common state – As sites and modalities are added, the logic for HP selection becomes more complex – HPs proliferate – Maintenance becomes difficult Need to centralize the logic and ease maintenance Need to manage not only new studies but also prior studies Rules engine simplifies management of common logic Rules can be shared and utilized in multiple HPs Updating a rule automatically updates it in every HP that uses it – No more searching for dozens of HPs to edit with every change! Rules can build on other rules – Break the problem down into its components – Think of rules as the RNA of the HP logic Prior relevancy can use rules in addition to ABP IBM Watson Health / © 2019 IBM Corporation / PAX Rev 4.0

More on composite worklist
Specialty - Neuro Multiple sets of worklist criteria – Individual worklist blocks are OR’ed together, creating a union of worklists Individual worklist blocks are generally not overlapping or only partially overlap All Studies in PACS One Worklist Global Stat Specialty - Neuro Local Plain Films My Studies My Studies Specialty - Neuro 1 Specialty - Neuro IBM Watson Health / © 2019 IBM Corporation / PAX Rev 4.0 29

More on ER/ED dimension
ER dimension is the communication path between ER physician and the reading radiologist ER READ – ER/ED Panel provides documentation of “wet read” findings – Radiologist agree or disagree is documented in the ER panel – ‘Disagree’ status can return the study to the ER physician’s worklist – Can be supplemented with Critical Results workflow if required by event – ER acknowledgement of the disagreement can be captured RAD READS RAD DISAGREE RAD AGREE ER RESOLVED IBM Watson Health / © 2019 IBM Corporation / PAX Rev 4.0

More on advanced workflow management

More on the Active Distribution Engine

Example of workflow reports Task Volumes
Example: Stats on how long it took an exam to go from un-read to read IBM Watson Health / © 2019 IBM Corporation / PAX Rev 4.0 IBM Watson Health / © 2019 IBM Corporation

Example of workflow reports Turn-Around Time
Example: Critical results, ER reads, direction physician follow-up status (call to communication), etc. IBM Watson Health / © 2019 IBM Corporation / PAX Rev 4.0 IBM Watson Health / © 2019 IBM Corporation

Example of workflow reports Radiologist Productivity
Example: Radiologist by modality/procedure/reading pool and the number of exams read in a period, ranked against similar rad reads. Reports also monitor time from open-to-read to final. IBM Watson Health / © 2019 IBM Corporation / PAX Rev 4.0 IBM Watson Health / © 2019 IBM Corporation

Example of workflow reports Exam Volumes
Example: Displays volume of study and exam count, along with number of unlinked studies and support filtering. IBM Watson Health / © 2019 IBM Corporation / PAX Rev 4.0 IBM Watson Health / © 2019 IBM Corporation

Example of workflow reports Assignment Volume
Example: Number of exams assigned per time period. IBM Watson Health / © 2019 IBM Corporation / PAX Rev 4.0 IBM Watson Health / © 2019 IBM Corporation

Example of workflow reports Assignment Turn-Around Time Statistics
Example: Shows assignments per radiologist on unread to read to final in minutes, with averages. IBM Watson Health / © 2019 IBM Corporation / PAX Rev 4.0 IBM Watson Health / © 2019 IBM Corporation

Accipio Ix™, MaxQ™ CT Studies from PACS Aimed at reducing time to clinical call, Accipio Ix is a workflow tool designed to aid in the acute care environment with prioritizing the clinical assessment of adult non-contrast head CT cases with features suggesting acute intracranial hemorrhage. – Helps prioritize critical cases for trauma and stroke care – Communicates with Merge PACS worklist – Can adjust the worklist’s priority based on findings – Provides a report for every analyzed case – Patient 1 – Patient 2 – Patient 3 – Patient 4 Bleed / No Bleed – Patient 3 – Patient 1 – Patient 2 – Patient 4 MaxQ and Accipio lx are the trademarks or registered trademarks of MaxQ-AI, Inc. or its affiliated companies in the United States and other countries. IBM Watson Health / © 2019 IBM Corporation / PAX Rev 4.0 39 IBM Watson Health / © 2019 IBM Corporation

Innovative reading workflows for enterprise radiology

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